ABSTRACT
Chapter 4 refines the procedure of the Dartmouth method, which pioneered the delineation of hospital service areas (HSAs) and hospital referral regions (HRRs) for the USA, and introduces a tool that automates the process in ArcGIS Pro. The Dartmouth method uses a simple plurality rule by assigning an area (e.g., a ZIP code area) to a hospital if its residents visit the hospital most often out of alternatives and then collects the areas assigned to the same hospital to form a preliminary HSA. Preliminary HSAs are then adjusted, often manually, to account for spatial adjacency and threshold localization index (LI) rate. LI is defined as the fraction of services provided by hospitals within an HSA out of the total service volume generated by patients in the same HSA. Our refined Dartmouth method eliminates the uncertainty and arbitrariness that require interactive decisions by an analyst. The automation not only makes the process efficient but also ensures that the results are consistent and replicable, two important properties in scientific research. A case study illustrates how to replicate the delineation of Dartmouth HSAs and HRRs in Florida by the automated tool and based on more recent data of all hospitalizations.
